The arterial hypertension diagnosis is based on office blood pressure measurement, and current guidelines suggest the use of out-of-office blood pressure measurement techniques in specific cases, as suspected white-coat or masked hypertension. Home Blood Pressure Monitoring (HBPM) is recommended as a complementary method to Ambulatory Blood Pressure Monitoring (ABPM). However usually HBPM is only used for implementing blood pressure control in treated patients. We tried to identify the accuracy between HBPM and ABPM in untreated patients. (We tried to identify HBPM accuracy between to ABPM in untreated patients.)Design and method:
We enrolled 83 consecutive untreated patients who performed ABPM in our Hypertension Unit and completed a short HBPM schedule (two measurements, twice daily, for four days) between November 2011 and June 2015. Patients were instructed about HBPM in accord to current hypertension guidelines and they used validated automated arm devices. We compared the accuracy between the two techniques and the HBPM ability to identify arterial hypertension in comparison with ABPM.Results:
Pearson's correlation coefficient between HBPM 4-day average and day-time ABPM values was 0.59 for systolic blood pressure (SBP) and 0.77 for diastolic blood pressure (DBP). Bland-Altman analysis revealed a mean difference of -5.68 mmHg, SD 8.82 mmHg for SBP, and -4.64, SD 6.33 mmHg for DBP. ROC curves described AUC for SBP of 0.75 and for DBP of 0.877. The ABPM identify as hypertensive 54 subjects on 83 (65.1%), the HBPM 29 subjects (34.9%), p-value 0.01609.Conclusions:
HBPM has a moderate correlation and a moderate accuracy in the identification of arterial hypertension compared with ABPM. Although HBPM is recommended as alternative method respect to ABPM, in untreated patients it is not reliable for arterial hypertension diagnosis and probably it is not able to identify specific hypertension patterns, in contrast with current guidelines.